=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093357014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HONOR ASSISTED LIVING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/10/2019
-----------------------------------------------------
Last Update Date | 10/10/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7412 E WETHERSFIELD RD
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-4719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-766-1099
-----------------------------------------------------
Fax | 480-629-5544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24247 N 81ST ST
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85255-2808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-766-1099
-----------------------------------------------------
Fax | 480-629-5544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO/OWNER
-----------------------------------------------------
Name | MR. BEHROUZ BARZANI
-----------------------------------------------------
Credential | MS
-----------------------------------------------------
Telephone | 732-766-1099
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------